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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Sigolene on October 1, 2000, at 3:18:51
I have been trying amisulpride for 19 days now.
Dosage were 25mg 3days, 50x4, 100x 12.
I still feel absolutely no effect. I took it for atypical depression, lake of energy, and maybe social phobia.
I wonder if it's worth continuating this trial ?
(i've heard that amisulpride was supposed to work in one week)
Thank for advice.
Sigolene
Posted by SLS on October 1, 2000, at 7:51:32
In reply to to amisulpride users, posted by Sigolene on October 1, 2000, at 3:18:51
> I have been trying amisulpride for 19 days now.
> Dosage were 25mg 3days, 50x4, 100x 12.
> I still feel absolutely no effect. I took it for atypical depression, lake of energy, and maybe social phobia.
> I wonder if it's worth continuating this trial ?
> (i've heard that amisulpride was supposed to work in one week)It is. Why don't you continue with it while you are deciding what to do next. AndrewB (are you watching?) will be able to give you a better idea as to whether there might be some people who need more than 100mg/day. If I were me (and I am from time to time), I would go back down to 50mg for at least a week to see what happens. If no luck, go to back up to 100 for a few days and then up to 150mg. Amisulpride seems to be a forgiving drug. If you are tolerating it well, why not? THEN, if no-go, hang out at 25mg for a few days when you reach this dosage on your discontinuation taper schedule.
> Thank for advice.
> SigoleneDon't thank me until you see what the amisulpride experts have to say.
Otherwise, you are welcome.
- Scott
Posted by JohnL on October 1, 2000, at 8:25:49
In reply to to amisulpride users, posted by Sigolene on October 1, 2000, at 3:18:51
Sigolene,If I were you, I would give it one more week. If you haven't improved dramatically (not just a little) by then, then I would stop it. It merely indicates that whatever chemistry is causing your problems, Amisulpride is not targeting it.
Amisulpride can indeed work in a week or less. With me I can feel it the first day even. That indicates that whatever chemistry is causing my troubles, Amisulpride is right on target. With you, there could likely be a different chemistry at fault. Amisulpride could still work through a domino chain reaction kind of effect, like anything else if given enough time, but the fact that it has done nothing so far indicates to me that it is nowhere close to being on-target with you.
So if it doesn't work and you must switch to something else, what to try next? Have you tried 2 or 3 SSRIs? If so, that would indicate that serotonin is not the chemistry at fault. Tricyclics like Desipramine or Nortriptyline? They are often the best, but have more side effects. They target norepinephrine chemistries. Adrafinil? This would target your norepinephrine chemistry, with few side effects.
And there is a chance your troubles aren't caused by a neurotransmitter deficiency at all. If that's the case, then a small dose of either Lithium (chemical smoother), or Depakote (electrical smoother) or Tegretol (electrical smoother) could be on target. Or maybe your transmitters are at good levels, but for some reason are failing to function properly...patchy performance, inadequate blood flow, etc. If that's the case, then you'll find dramatic improvement with Ritalin or Adderall.
I don't know your history, so I'm just posing the different scenarios you face. Hopefully some clues can be put together and it will make more sense. Amisulpride could indeed work well if given more time. But the fact that it hasn't worked yet raises questions.
John
Posted by Sigolene on October 1, 2000, at 9:19:46
In reply to Re: to amisulpride users, posted by JohnL on October 1, 2000, at 8:25:49
Jhon,
> The chimestry question is complicated. I'm trying to think what to try next, if amisulpride is not working. But this time i really don't know.
I want to treat depression first, social phobia, CFS and poor concentration, insomnia.
I can forget all the serotoninergic meds, they worsen my depression.
Regarding the NE meds, i don't know what to think because for example Ludiomil was effective on my atypical depression, but too much sedation and side effects. Then i tryed logically an other NE med less sedating: Reboxetine. But instead of improving my mood, it worsened it ! So i really don't understand anything with NE active medications.
I never had Ritalin because in Europe they don't give it easily. I also never had mood stabilizator (lithium, tegretol,...) because i'm not manic and i don't like to take too many different meds.
Well, now in possession of all this informations, do you have a suggestion ?
(in Europe we also don't have Burpropion, it's a shame)
Sigolene.> Sigolene,
>
> If I were you, I would give it one more week. If you haven't improved dramatically (not just a little) by then, then I would stop it. It merely indicates that whatever chemistry is causing your problems, Amisulpride is not targeting it.
>
> Amisulpride can indeed work in a week or less. With me I can feel it the first day even. That indicates that whatever chemistry is causing my troubles, Amisulpride is right on target. With you, there could likely be a different chemistry at fault. Amisulpride could still work through a domino chain reaction kind of effect, like anything else if given enough time, but the fact that it has done nothing so far indicates to me that it is nowhere close to being on-target with you.
>
> So if it doesn't work and you must switch to something else, what to try next? Have you tried 2 or 3 SSRIs? If so, that would indicate that serotonin is not the chemistry at fault. Tricyclics like Desipramine or Nortriptyline? They are often the best, but have more side effects. They target norepinephrine chemistries. Adrafinil? This would target your norepinephrine chemistry, with few side effects.
>
> And there is a chance your troubles aren't caused by a neurotransmitter deficiency at all. If that's the case, then a small dose of either Lithium (chemical smoother), or Depakote (electrical smoother) or Tegretol (electrical smoother) could be on target. Or maybe your transmitters are at good levels, but for some reason are failing to function properly...patchy performance, inadequate blood flow, etc. If that's the case, then you'll find dramatic improvement with Ritalin or Adderall.
>
> I don't know your history, so I'm just posing the different scenarios you face. Hopefully some clues can be put together and it will make more sense. Amisulpride could indeed work well if given more time. But the fact that it hasn't worked yet raises questions.
> John
Posted by SLS on October 1, 2000, at 9:36:56
In reply to Re: to amisulpride users, posted by JohnL on October 1, 2000, at 8:25:49
Andrew does better at 50mg than he does at 100mg. Sigolene was not at 50mg for a week. Only 4 days. A Dr. Levine in NYC specializing in TRD and experienced with sulpiride counseled my old doctor that 50mg of sulpiride (the archetypical substituted benzamide neuroleptic displaying a preference for DA presynaptic autoreceptors) was more effective than 100mg. That would equate to no more than 25mg of amisulpride. I found this to be true, as the small improvement sulpiride gave me disappeared immediately when I increased the dosage to 100mg. Perhaps Sigolene will respond at 25mg and not at 50mg. She took 25mg for only 3 days. There is probably a point at which there is a reversal of net DA activity. This would be evidenced by both Andrew's experience with amisulpride and mine with sulpiride. I would say that it is unlikely that Sigolene will respond to amisulpride at this point, but I can't say for sure how her brain works, nor have I seen a large study producing a statistical range of the lengths of time needed for improvements to become evident in responders to amisulpride. I cannot tell her that she won't yet respond.
The drug ain't hurting her. Studies of the use of amisulpride in major depression and dysthymia set the target dosage at 50mg. If she has nothing else better to do at this point, I think she should explore the bottom end, and perhaps the top end, of this drug's antidepressant dosage range. It would be ashame to later come back to amisulpride because of a "what if".
Just a bit of common sense, that's all. (Always easier said than done).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9892856&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9495601&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9165379&dopt=Abstract
By the way, I had my doctor ask Dr. Levine about amisulpride. He said that it was too much of an antipsychotic, and sulpiride would be the better of the two for depression. The binding affinity of amisulpride to DA D2 and D3 receptors is much greater than that of sulpiride. Amisulpride probably has a narrower and finicky window of dosages in which one can adjust for its antidepressant result.
The same pharmaceutical company, Sanofi, markets both sulpiride (Dogmatil) and amisulpride (Solian). Sulpiride is an old drug that is dirt cheap. They can't raise the price on it - sort of like rent-control, so of course they are going to push amisulpride as being better than sulpiride. Amisulpride is much, much more expensive than sulpiride and represents a profit potential an order of magnitude greater than that they are "suffering" from with sulpiride.
Definitely pass the salt on this one.
- Scott
Posted by Sigolene on October 1, 2000, at 10:14:20
In reply to Re: to amisulpride users » JohnL, posted by SLS on October 1, 2000, at 9:36:56
This research compare dosage between 50 to 300 mg amisulpride and conclusion is that the best dosage was 100mg
(sorry i don't know how to put this directly on hypertext link in blue)
Sigolene
Posted by AndrewB on October 1, 2000, at 13:20:31
In reply to to amisulpride users, posted by Sigolene on October 1, 2000, at 3:18:51
Sigolene,
Thank you for telling us how your amisulpride trial is going.
It is a bit of a mystery what is going on here. Your history strongly suggests dopaminergic dysfunction. It is my belief that people can be mute (unresponsive) to amisulpride yet still have D2/D3 dopamine receptor dysfunction.
The fact that you have had no response means to me that your dopamine system isn't being effected by the amisulpride, otherwise you would get some effect one way or another. So you still need to find a way to stimulate these D2/D3 receptors and see if you benefit from it.
First step is to try amisulpride at 150mg. for 7 days. Maybe you require a higher dose. Some people do I think. I don't think you need to explore to low end. I don't think people experience nothing at 50 yet have a response at 25.
But what if you still don't respond to amisulpride at 150mg? I suggest you try a stimulant, not ritalin, preferably adderall. It is dopaminergic that has shown to be effective in some with dysthymia/atypical depression and CFS. I believe it also can help those with social anxiety due to dopaminergic dysfunction. Email me at andrewb@seanet.com and I can give you suggestions on how to obtain adderall for a trial.
Depending on your response to adderall you may need to try yet another dopaminergic. We're getting ahead of ourselves, but pramipexole (Mirapex) is another option for you. Reports seem to indicate it to be effective for vegetative atypical. It is my hunch that where amisulpride is ineffective with D2/D3 dysfunction, pramipexole may be effective. However, if memory serves me, pramipexole is not available in your country. In this case you would substitute it with Requip (ropinirole). If you decide to try this I can give you instructions for your trial.
Then we come to MAOIs. Sorry if I have already asked you this, but what has been your experience with them, have you tried any of them? They are standard treatment for atypical and social phobia. I think they are overused and should not be used unless other options fail due to their common side effects but sometimes they are all that works.
I hope this advice gives you some options and inspires you to fully explore dopaminergic dysfunctin, for which I believe you likely suffer from.
Please keep us informed on how you are doing and how the meds are working. I'm very much hoping that something can be found to work for you.
BTW, thank you Scott for the info on Sulpiride, perhaps sulpiride should be used more. Perhaps it can be effective where amisulpride fails. I hope to see reports from people who have tried both to see if they have real differences in response rates. Most of all I am glad to see you posting again.
Best wishes,
AndrewB
Posted by JohnL on October 2, 2000, at 2:43:10
In reply to Re: to amisulpride users » JohnL, posted by Sigolene on October 1, 2000, at 9:19:46
Hi again Sigolene,
You're right...NE meds are weird. I too tried tricyclics (Nortriptyline, Desipramine) but couldn't take the side effects. They did not however make me worse, but instead perhaps a little better. Then I too tried Reboxetine and got much much worse very fast. Same thing again with Moclobemide. Most NE meds make me worse, but some make me much better. I don't know why. It must be something at the molecular level that the body either embraces or rejects.Anyway, here's an idea...you could add Adrafinil to your Amisulpride. When I started Amisulpride, it worked fast but then kind of leveled off and didn't feel as good as it did at first. When I added Adrafinil to it, it's like it turbocharged everything. The results are more than the sum of the two. The same thing happened with Adrafinil...it worked fast, but then kind of faded, but worked better than ever when I added Amisulpride to it. Either way. The two together can work awesome, much better than either alone. I don't know why. There must be something synergistic about them at a molecular level, something that has nothing to do with NE or dopamine. Something else. Whatever it is, it's good.
Another idea...since serotonin reuptake inhibitors work poorly for you, then logic implies a serotonin reuptake enhancer might work instead. Tianeptine.
We could probably brainstorm more ideas, but these two look the most promising to me for your unique situation. Add Adrafinil to Amisulpride. Or, try Tianeptine alone, or perhaps with Amisulpride.
Just thinking out loud. Hope these ideas might help in some way.
John
Posted by Sigolene on October 2, 2000, at 4:10:13
In reply to Re: to amisulpride users, posted by AndrewB on October 1, 2000, at 13:20:31
Andrew,
Regarding MAOI, i tried Moclobemide (aurorix). It was effective for depression but not for attention deficit. But the problem was i couldn't sleep, even with a small dose. And i think it's contraindicated to add an other sedative AD like Trazadone with an MAOI for sleep. What do you think ?
> Sigolene,
>
> Thank you for telling us how your amisulpride trial is going.
>
> It is a bit of a mystery what is going on here. Your history strongly suggests dopaminergic dysfunction. It is my belief that people can be mute (unresponsive) to amisulpride yet still have D2/D3 dopamine receptor dysfunction.
>
> The fact that you have had no response means to me that your dopamine system isn't being effected by the amisulpride, otherwise you would get some effect one way or another. So you still need to find a way to stimulate these D2/D3 receptors and see if you benefit from it.
>
> First step is to try amisulpride at 150mg. for 7 days. Maybe you require a higher dose. Some people do I think. I don't think you need to explore to low end. I don't think people experience nothing at 50 yet have a response at 25.
>
> But what if you still don't respond to amisulpride at 150mg? I suggest you try a stimulant, not ritalin, preferably adderall. It is dopaminergic that has shown to be effective in some with dysthymia/atypical depression and CFS. I believe it also can help those with social anxiety due to dopaminergic dysfunction. Email me at andrewb@seanet.com and I can give you suggestions on how to obtain adderall for a trial.
>
> Depending on your response to adderall you may need to try yet another dopaminergic. We're getting ahead of ourselves, but pramipexole (Mirapex) is another option for you. Reports seem to indicate it to be effective for vegetative atypical. It is my hunch that where amisulpride is ineffective with D2/D3 dysfunction, pramipexole may be effective. However, if memory serves me, pramipexole is not available in your country. In this case you would substitute it with Requip (ropinirole). If you decide to try this I can give you instructions for your trial.
>
> Then we come to MAOIs. Sorry if I have already asked you this, but what has been your experience with them, have you tried any of them? They are standard treatment for atypical and social phobia. I think they are overused and should not be used unless other options fail due to their common side effects but sometimes they are all that works.
>
> I hope this advice gives you some options and inspires you to fully explore dopaminergic dysfunctin, for which I believe you likely suffer from.
>
> Please keep us informed on how you are doing and how the meds are working. I'm very much hoping that something can be found to work for you.
>
> BTW, thank you Scott for the info on Sulpiride, perhaps sulpiride should be used more. Perhaps it can be effective where amisulpride fails. I hope to see reports from people who have tried both to see if they have real differences in response rates. Most of all I am glad to see you posting again.
>
> Best wishes,
>
> AndrewB
Posted by SLS on October 2, 2000, at 10:48:49
In reply to Re: to amisulpride users, posted by AndrewB on October 1, 2000, at 13:20:31
Dear Sigolene,
I must apologize if I guessed wrong regarding your gendre.
Are you male or female?
Sorry.
--------------------------------------------------------
Hi Andrew.
> > I would go back down to 50mg for at least a week to see what happens> > First step is to try amisulpride at 150mg. for 7 days. Maybe you require a higher dose. Some people do I think. I don't think you need to explore to low end. I don't think people experience nothing at 50 yet have a response at 25.
The reason I would rather have someone in Sigolene's situation go down first rather than up in dosage is in an effort to avoid inducing an upregulation of the presynaptic membrane, just in case the effective dosage window lies beneath 100mg. If such an upregulation were to occur, she might become less likely to respond to amisulpride quickly at the lower dosage. After upregulation, there would need to be a higher concentration of amisulpride available to bind to the increased number of autoreceptors. With amisulpride (not so much with sulpiride), at the higher dosage now necessary to occupy sufficient presynaptic autoreceptors to effect the negative feedback loop, I believe that too many postsynaptic receptors will become blocked so as to prevent an antidepressant response to occur. Amisulpride is now acting more like an antipsychotic and less like an antidepressant. After a few weeks at too high a dosage, it might take a full two weeks after dosage reduction for the presynaptic membranes to settle back down via downregulation to nominal levels. Prior to downregulation, the supersensitive membrane will not allow the lower dosage of amisulpride to effect the negative feedback loop, and an antidepressant response becomes less likely to occur, even if it is the right dosage. Now, you need to test this new level of presynaptic sensitivity for at least one week more.
If Sigolene goes down in dosage first without results, she can probably go immediately to 150-200mg without adverse sequale. This algorithm would save a month and accomplish the same thing.
This was my rationale for suggesting reducing the dosage first.
* One clue as to Sigolene's dopaminergic tone might be if she experiences an exacerbation of depression (worse than baseline) after discontinuing the amisulpride. If she does, perhaps sulpiride, or low-dose Zyprexa or Risperdal, combined with Mirapex would work. I would also like to see an MAOI come into the picture. Maybe Wellbutrin. Definitely amineptine. Crap.
See ya'
- Scott
Posted by KarenB on October 2, 2000, at 11:55:31
In reply to to amisulpride users, posted by Sigolene on October 1, 2000, at 3:18:51
> I have been trying amisulpride for 19 days now.
> Dosage were 25mg 3days, 50x4, 100x 12.
> I still feel absolutely no effect. I took it for atypical depression, lake of energy, and maybe social phobia.
> I wonder if it's worth continuating this trial ?
> (i've heard that amisulpride was supposed to work in one week)
> Thank for advice.
> SigoleneWorks wonders when taken with a stimulant, like Adderall. Worthless without it, for the symptoms you describe.
Just my humble opinion.
Karen
Posted by JasonL on October 2, 2000, at 13:47:00
In reply to Re: to amisulpride users, posted by KarenB on October 2, 2000, at 11:55:31
> Works wonders when taken with a stimulant, like Adderall. Worthless without it, for the symptoms you describe.
>
> Just my humble opinion.
>
> KarenKaren,
You are taking amisulpride, adrafanil, and Aderall? You had mentioned that you have ADD...I think it is quite possible that I have ADD as well. I have going through severe depression for several years, symptoms priamrily depressed state of no joy, no motivation, confusion about life. Anti-depressents to this point have never done a thing. When you say atypical, are you refering to treatment resistent?
JasonL
Posted by Sigolene on October 2, 2000, at 13:53:26
In reply to to amisulpride users, posted by Sigolene on October 1, 2000, at 3:18:51
don't worry i'm just a women.
(i'm joking)
Sigolene
Posted by Sigolene on October 2, 2000, at 13:58:04
In reply to Re: to amisulpride users, posted by KarenB on October 2, 2000, at 11:55:31
Karen,
We don't have Adderal here in Europe, but i think Ritalin is quite the same as Adderal. So i'll try Ritalin.
But have you already tried to take only adderal without amisulpride ? and what result ?
Sigolene
Posted by SLS on October 2, 2000, at 14:54:32
In reply to Re: to amisulpride users » KarenB, posted by Sigolene on October 2, 2000, at 13:58:04
> Karen,
>
> We don't have Adderal here in Europe, but i think Ritalin is quite the same as Adderal. So i'll try Ritalin.Dexedrine is the closest thing to Adderal. As a matter of fact, Dexedrine is one of the components of Adderal.
- Scott
Posted by Michael K on October 6, 2000, at 21:09:49
In reply to Re: to amisulpride users » AndrewB, posted by Sigolene on October 2, 2000, at 4:10:13
> Andrew,
>
> Regarding MAOI, i tried Moclobemide (aurorix). It was effective for depression but not for attention deficit. But the problem was i couldn't sleep, even with a small dose. And i think it's contraindicated to add an other sedative AD like Trazadone with an MAOI for sleep. What do you think ?Sigolene,
There is no problem using an MAOI with Trazadone added for sleep. I currently take 80 mg Parnate and 200 mg Trazodone before bed. In any event, good luck. I'll be watching this thread for new ideas.
Mike
>
> > Sigolene,
> >
> > Thank you for telling us how your amisulpride trial is going.
> >
> > It is a bit of a mystery what is going on here. Your history strongly suggests dopaminergic dysfunction. It is my belief that people can be mute (unresponsive) to amisulpride yet still have D2/D3 dopamine receptor dysfunction.
> >
> > The fact that you have had no response means to me that your dopamine system isn't being effected by the amisulpride, otherwise you would get some effect one way or another. So you still need to find a way to stimulate these D2/D3 receptors and see if you benefit from it.
> >
> > First step is to try amisulpride at 150mg. for 7 days. Maybe you require a higher dose. Some people do I think. I don't think you need to explore to low end. I don't think people experience nothing at 50 yet have a response at 25.
> >
> > But what if you still don't respond to amisulpride at 150mg? I suggest you try a stimulant, not ritalin, preferably adderall. It is dopaminergic that has shown to be effective in some with dysthymia/atypical depression and CFS. I believe it also can help those with social anxiety due to dopaminergic dysfunction. Email me at andrewb@seanet.com and I can give you suggestions on how to obtain adderall for a trial.
> >
> > Depending on your response to adderall you may need to try yet another dopaminergic. We're getting ahead of ourselves, but pramipexole (Mirapex) is another option for you. Reports seem to indicate it to be effective for vegetative atypical. It is my hunch that where amisulpride is ineffective with D2/D3 dysfunction, pramipexole may be effective. However, if memory serves me, pramipexole is not available in your country. In this case you would substitute it with Requip (ropinirole). If you decide to try this I can give you instructions for your trial.
> >
> > Then we come to MAOIs. Sorry if I have already asked you this, but what has been your experience with them, have you tried any of them? They are standard treatment for atypical and social phobia. I think they are overused and should not be used unless other options fail due to their common side effects but sometimes they are all that works.
> >
> > I hope this advice gives you some options and inspires you to fully explore dopaminergic dysfunctin, for which I believe you likely suffer from.
> >
> > Please keep us informed on how you are doing and how the meds are working. I'm very much hoping that something can be found to work for you.
> >
> > BTW, thank you Scott for the info on Sulpiride, perhaps sulpiride should be used more. Perhaps it can be effective where amisulpride fails. I hope to see reports from people who have tried both to see if they have real differences in response rates. Most of all I am glad to see you posting again.
> >
> > Best wishes,
> >
> > AndrewB
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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